An 81-year-old woman presented with a 2-week history of multiple pruritic papules. The lesions were located on her lower abdomen and both popliteal areas (Figure 1A). She had no systemic complaints. The patient had grown vegetables on a hill near her village for several months. On close inspection, minute brown organisms were observed at the center of each papule (Figure 1A, inset). A punch biopsy was performed on an abdominal lesion, and all other arachnids were removed by forceps.